1078 The Journal of Rheumatology 2009; 36:5; doi:10.3899/jrheum.080952 Personal non-commercial use only. The Journal of Rheumatology Copyright © 2009. All rights reserved. Clinical Remission in Patients with Systemic Juvenile Idiopathic Arthritis Treated with Anti-Tumor Necrosis Factor Agents RICARDOA.G.RUSSOandMARÍAM.KATSICAS ABSTRACT. Objective. To assess the frequency of clinical remission in a cohort of patients with systemic juve- nileidiopathicarthritis(JIA)whoreceivedcontinuousanti-tumornecrosisfactor(TNF)therapy;and to identify potential predictors of remission. Methods. Patients with systemic JIA who were treated with anti-TNF agents for > 6 months were studied. Demographic and nosologic variables recorded at the start of anti-TNF therapy were ana- lyzed.Associationbetweenearlyvariablesand occurrenceofremissionwasevaluatedthroughCox proportional hazard regression analysis. Results. Forty-fivepatientswereincluded(30girls),medianage9years(range2–17yrs),ageatdis- ease onset 5 years (range 0.5–15), disease duration 3 years (range 0.5–13). Twenty-one (47%) chil- dren showed systemic symptoms at the start of anti-TNF therapy. Patients received therapy for 24 months (range 6–88): 45 (100%) were given etanercept, 17 (38%) infliximab, and 5 (11%) adali- mumab, in combination with methotrexate. Anti-TNF switching was performed in 22 (49%) chil- dren. Eleven (24%) met definition criteria for remission while taking etanercept (n = 8), infliximab (2), or adalimumab (1). Remission occurred following 26 (range 9–65) months of therapy. Flares occurredin5(45%)patients2to14monthsafterremissionwasfirstrecorded.Absenceofsystemic symptomsatthestartoftherapyandfulfilmentofimprovementcriteriaatMonth3wereassociated with remission in univariate analysis; no variable showed any association in multivariate analysis. Conclusion. Twenty-four percent of patients with systemic JIA experienced remission with anti-TNF therapy, but only 13% experienced sustained benefit. (First Release April 1 2009; J Rheumatol 2009;36:1078–82; doi:10.3899/jrheum.080952) Key Indexing Terms: JUVENILE SYSTEMICARTHRITIS REMISSION ANTI-TUMOR NECROSIS FACTORAGENTS ETANERCEPT From the Servicio de Inmunología y Reumatología, Hospital de Pediatría “Prof. Dr. Juan P. Garrahan,” Buenos Aires, Argentina. R.A.G. Russo, MD; M.M. Katsicas, MD. Address reprint requests to Dr. R.A.G. Russo, Servicio de Inmunología y Reumatología, Hospital de Pediatría “Prof. Dr. Juan P. Garrahan,” Pichincha 1880, 1245 Buenos Aires, Argentina. E-mail: rrusso@garrahan.gov.ar Accepted for publication December 23, 2008. Systemic juvenile idiopathic arthritis (JIA) is one of the most severe forms of JIA, frequently leading to severe dis- ability and significant mortality 1 .Additionally,accordingto different investigators, patients with systemic JIA frequent- ly show a mediocre response to therapy with methotrexate (MTX) and anti-tumor necrosis factor (TNF) agents 2-5 . However, some patients with systemic JIA have been observed to respond to TNF inhibitors as satisfactorily as patientswithotherformsofJIA,atleastincontrolledtrials, and they may even achieve remission on this therapy 6 . While the American College of Rheumatology Pediatric 30%,50%,70%,and90%improvementcriteria(ACRPedi 30,50,70,and90)havebeenthemostwidelyreportedout- comesinclinicaltrialsandobservationalstudiesonefficacy of biologic agents in JIA, remission — a more robust indi- catorofefficacy—hasseldombeenreported. Definitions for inactive disease and remission in JIA (based on clinical criteria) have recently been elaborated. According to these definitions, remission is the presence of inactivediseaseforatleast6consecutivemonths 7 .Although remission is the ultimate goal of treatment in JIA, the per- centage of children with systemic JIA who meet remission criteria on therapy with biologic agents has not been tested in recent controlled trials. However, rates of remission with TNF inhibitors have been reported in some observational, registry-basedstudiesinadultswithrheumatoidarthritisand children with JIA 8-11 .ArecentreportfromaDutchregistry onetanerceptinJIAshowedthatchildrenwithsystemicJIA mayreachremissionratesthataresimilartothoseachieved bypatientswithotherformsofJIA 11 .Todate,nostudyhas focusedoninactivediseaseandremissionratesachievedby patients with systemic JIAtreated with anti-TNF agents. We reviewed our experience to assess the frequency of inactive disease and remission observed in a cohort of patients with systemic JIA who have received TNF anta- gonists, and to identify potential predictors of remission. www.jrheum.org Downloaded on November 28, 2021 from